SportMonday, December 7th

Concussion: rugby's latest bogeyman

The oncoming defender, whether through mistake or malice, collided with the airborne full-back’s legs, flipping him violently through the air. He landed defenceless on the wet North Herefordshire turf directly in front of the stand. The impact of the fall could be heard above the cheers.

Rugby is more physical now than it ever has been at the top level, and yet safer than it ever has been for youngsters starting out on a Sunday morning across the county.

But increasingly the sport is being forced to confront the question of safety, and by extension, undertake a searching and fearless moral inventory of what it is, what it gives and what it risks.

Joe Doyle (15) takes a high ball for Luctonians, only to be taken out by the Macclesfield number 6, flipping him and landing on his head and shoulders. (image by Nigel Mee)

The incident described above occurred last month, in a game against Macclesfield.

Doyle - a star player for a Luctonians’ side competing in the fourth tier of English rugby - lay face down on the turf for a long minute while the club’s doctor and sports therapist attended to him.

The watching crowds’ cheers at Doyle’s initial bravery, soon turned to jeers, directed at the offending Macclesfield player, and then to a hushed quiet. Only one of the players involved in the collision left the field. Doyle got up and completed the 80 minutes.

“I never felt pressured to carry on,” said Doyle.

“I trust the medical team and their judgements. If I had to come off for further assessment, I wouldn’t have been happy about it – but I would have done it.

“Being a dad is a massive part of my life now, but my attitude is the same as everyone else in our team. I have to give 100 per cent. They rely on me and I rely on them.”

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As a player, it's a worry and one you don't want to think about

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There are some hard truths surrounding the issue of injuries within rugby at its highest level:

More professional players are being forced out of the game through injury year on year, according to the Rugby Players' Association.

Among those to retire in last 12 months are Shontayne Hape and Jonathan Thomas, both citing multiple head traumas.

Hape, a former England centre, gave an open and honest account of playing through head injuries, self-medicating and memory loss - to the point where, at 33, he couldn’t remember his own PIN number.

At a rate of 10.5 per 1000 player hours, Premiership rugby’s number of reported concussions now outstrips the NFL – a league where two former players recently committed suicide by shooting themselves in the chest so that their brains could be studied for degenerative diseases that have been linked to repetitive head trauma.

The modern game is brilliant and it is brutal.

“You don’t know unless you are in the middle of it,” said former Hereford flanker, Guy Thompson, now playing for Premiership side Wasps.

“From the outside it looks like a battle – and it can look ugly, and you can get hurt – but everything is done with control and composure.”

A series of law changes over the last ten years have all but outlawed any instance where a player could be put at risk.

“They have taken out tipping in the tackle, they come down heavily on anyone who interferes with a jumper in the lineout or on a kick chase, you can’t leave your feet when you are approaching a ruck and you can’t hit anywhere near the head.

“If they took anything else away, it would change the game entirely. You might as well play tag rugby.”

Guy Thompson, a former Bishop of Hereford Bluecoat School pupil, is in his third season with Premiership side Wasps.

And tag rugby, for some, may seem like an appropriate response.

However, we manage risk in any sport – in fact in any part of life.

Five people die every day on the UK roads, yet we still drive.

“We do everything we can to minimise the risk, but there is always going to be a point where as adults you accept it because the benefits far outweigh that risk,” said Malcolm Harris, secretary of Hereford Rugby Club, a county rugby coach and the head of Hereford’s mini-section for ten years.

He is also a father of three.

“Kids come back from ski trips with broken wrists and broken legs but there is no clamour to ban the sport.

“At Wyeside we have 300 kids playing rugby every Sunday and maybe one or two go home with a minor head injury.”

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The road death analogy takes on an added significance given that, at the top level, each match has been proved to inflict upon the players the same physical trauma as a car crash at 30mph.

Those players are paid to go out and experience repeated car crashes week after week after week for seven months.

It takes a shocking physical toll. One that has never before been seen in the sport and one for which the long term effects are still shrouded in speculation.

But efforts are being made to monitor it, and reduce the chances of residual damage.

Thompson undergoes a cognitive baseline test on a laptop at the start of the year at Premiership side Wasps.

Then, any time he is suspected of suffering a concussion he must retake the test and if his scores dip below the preseason numbers, he is taken out of training until he can complete the test to that standard, at which point he would complete a five-day protocol that introduces him back into full training.

“Of course it’s talked about,” he said.

“It’s a worry and it’s one you don’t want to think about. If you start second guessing yourself in contact, you could end up worse.”

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The science surrounding concussions remains inexact.

However, doctors on both sides of the Atlantic are performing extensive research to determine the danger of suffering head injuries, with Saracens players each being fitted with a sensor that measures the speed, torque and frequency of any sudden movement of the head.

Accepted wisdom says that while shaking the brain is never good, the danger comes when it occurs several times in succession – whether in the same game, or over consecutive weeks.

And this is the greatest defence rugby against both short- and long-term harm to its players.

“It’s where the comparison to NFL falls down,” said Thompson.

“American football is a business – and it’s a business from high school, college. Young players are under real pressure not to step out because there’s not really many routes back into the NFL if you don’t make it young.

“And then when players are cut from teams, or they retire, they are on their own.

“The Rugby Players Association is good at helping players after they retire, and if ever you were suffering from depression or some of those symptoms, you could go to them independently for advice without it getting back to your club.

“But generally playing through concussion is not a badge of honour any more.

“The buck stops with the wellbeing of the player in rugby. You are looked out for.

“Boys are much more likely to go across to a player and see if he’s okay. But having that 10-minute concussion test to take the adrenaline out of it and the pressure on docs – that’s a good thing.

“As a player you’re always going to feel like you could carry on.

“But we are drilled with information about head injuries, we do prehab exercises for neck strength and ultimately we are monitored to the highest degree.”

Youth rugby – as you would expect – is similarly policed with a high-level of vigilance, despite a much lower level of risk.

Mike Stubbs, who heads up the PE department at Hereford school rugby powerhouse the Bishop of Hereford Bluecoat school, says any suspected head injury is treated the same.

“Any problem, I pull them out straight away. Then the pupil is sent home with a letter and given an RFU booklet outlining concussion symptoms and information.

“We’re well-qualified as PE teachers to identify sports injuries, but we are also well-placed as teachers to notice when a young person’s behaviour has changed. We see them every day, we know when something isn’t right.”

Stubbs, who coached Hereford Rugby Club to two promotions in five years, says that when it comes to safeguarding the legacy of the sport he loves, the key is education.

“The more we know the better. That’s the bottom line.

"Things will always be moving forward – there have been football players from the ‘60s and 70s who have suffered later in life from heading heavy footballs throughout their careers – but a little knowledge can be dangerous.

“At youth level, rugby is not a dangerous sport, I can say that categorically. The risks are no greater than were you playing, for example, football.

“It is a physical sport and there will be minor injuries. But I firmly believe that what the sport gives you far outweighs that.”

And, a far cry from the hackneyed image of the overbearing dad with a whistle screaming from the sideline, today’s youth and mini-rugby coaches are as qualified as they ever have been.

To coach young people now, the RFU stipulates that you must go through two separate courses, both of which encompass a first aid element that deal with concussion.

They also deal with player welfare, and stress the importance of a young person’s long-term future in the game over the winning an under-12 derby game, or “digging in” and playing through injury as Jonathan Thomas termed it in his retirement statement.

It is perhaps for reasons like this – and in no short part as a result of the recent Rugby World Cup – that while 50 percent of US parents said in a recent Bloomberg survey that they do not want their children playing American Football, there are still 300 kids running around at Hereford RFC every Sunday, and the same again at Luctonians.

“Would I be worried for the health of my sons if they had a chance to play rugby professionally?” said Harris.